DETERMINANTS OF CHANGE IN MEDICAID PHARMACEUTICAL COST-SHARING - DOESEVIDENCE AFFECT POLICY

Since 1980, many Medicaid programs have instituted, adjusted, or aboli shed pharmaceutical copayments or limitations on the number of prescri ptions per patient (caps). Studies indicate that prescription caps can harm patients and increase Medicaid costs. However, because there is little information on how state policy makers select and evaluate such policies, in-depth telephone interviews were conducted with key infor mants in Medicaid programs that had recently made changes in cost-shar ing policies. Among the barriers to evidence-based policy making were lack of political power, skills, and infrastructure; crisis-oriented d ecisions; compartmentalized budgeting; lack of advocates for disadvant aged patients; and the absence of timely research. Research was applie d successfully when the interests of patient advocates and the drug in dustry were aligned and when Medicaid analysts were able to identify a nd communicate relevant research to policy makers at the time, or ''te achable moment,'' that policy was being changed.